Mexican-American Women's Lifelong Residence in the United States Is Associated with an Increased Risk of Gastroschisis: A Population-Based Study

OBJECTIVE

To determine whether nativity is associated with abdominal wall defects among births to Mexican-American women.

STUDY DESIGN

Using a cross-sectional, population-based design, stratified and multivariable logistic regression analyses were performed on the 2014-2017 National Center for Health Statistics live-birth cohort dataset of infants of US-born (n = 1 398 719) and foreign-born (n = 1 221 411) Mexican-American women.

RESULTS

The incidence of gastroschisis was greater among births to US-born compared with Mexico-born Mexican-American women: 36.7/100 000 vs 15.5/100 000, RR = 2.4 (2.0, 2.9). US-born (compared with Mexico-born) Mexican-American mothers had a greater percentage of teens and cigarette smokers, P < .0001. In both subgroups, gastroschisis rates were greatest among teens and decreased with advancing maternal age. Adjusting for maternal age, parity, education, cigarette smoking, pre-pregnancy body mass index, prenatal care usage, and infant sex), OR of gastroschisis for US-born (compared with Mexico-born) Mexican-American women was 1.7 (95% CI 1.4-2.0). The population attributable risk of maternal birth in the US for gastroschisis equaled 43%. The incidence of omphalocele did not vary by maternal nativity.

CONCLUSIONS

Mexican-American women's birth in the US vs Mexico is an independent risk factor for gastroschisis but not omphalocele. Moreover, a substantial proportion of gastroschisis lesions among Mexican-American infants is attributable to factors closely related to their mother's nativity.

Evaluation of omadacycline against intracellular Mycobacterium abscessus in an infection model in human macrophages

Background

Omadacycline is an aminomethylcycline antibiotic in the tetracycline class that was approved by the US FDA in 2018 for the treatment of community-acquired bacterial pneumonia and acute bacterial skin and skin structure infections. It is available in both IV and oral formulations. Omadacycline has broad-spectrum in vitro activity and clinical efficacy against infections caused by Gram-positive and Gram-negative pathogens. Omadacycline is being evaluated in a 3 month placebo-controlled Phase 2 clinical trial of oral omadacycline versus placebo in adults with non-tuberculous mycobacteria (NTM) pulmonary disease caused by Mycobacterium abscessus (NCT04922554).

Objectives

To determine if omadacycline has intracellular antimicrobial activity against NTM, bacteria that can cause chronic lung disease, in an ex vivo model of intracellular infection.

Methods

Two strains of M. abscessus were used to infect THP-1 macrophages. Intracellular M. abscessus was then challenged with omadacycline and control antibiotics at multiples of the MIC over time to evaluate intracellular killing.

Results

At 16 ×  the MIC at 72 h, omadacycline treatment of intracellular NTM yielded a log10 reduction in cfu of 1.1 (91.74% reduction in cfu) and 1.6 (97.65% reduction in cfu) consistent with killing observed with tigecycline, whereas amikacin and clarithromycin at 16 ×  the MIC did not show any reduction in cfu against the intracellular M. abscessus.

Conclusions

Omadacycline displayed intracellular activity against M. abscessus within macrophages. The activity was similar to that of tigecycline; as expected, intracellular killing was not observed with clarithromycin and amikacin.

Women's Economic Mobility and Small for Gestational Age Rates: The Effect of Paternal Early-Life Socioeconomic Position

OBJECTIVE

To determine whether paternal early-life socioeconomic position (defined by neighborhood income) modifies the association of maternal economic mobility and infant small for gestational age (weight for gestational age < 10th percentile, SGA) rates.

METHODS

Stratified and multilevel binomial regression analyses were executed on the Illinois transgenerational dataset of parents (born 1956-1976) and their infants (born 1989-1991) with appended U.S. census income information. Only Chicago-born women with an early-life residence in impoverished or affluent neighborhoods were studied.

RESULTS

The incidence of impoverished-born women's upward economic mobility among births (n = 3777) with early-life low socioeconomic position (SEP) fathers was less than that of those (n = 576) with early-life high SEP fathers: 56% vs 71%, respectively, p < 0.01. The incidence of affluent-born women's downward economic mobility among births (n = 2370) with early-life low SEP fathers exceeded that of those (n = 3822) with early-life high SEP fathers: 79% vs 66%, respectively, p < 0.01. The adjusted RR of infant SGA for maternal upward (compared to lifelong impoverishment) economic mobility among fathers with early-life low and high SEP equaled 0.68 (0.56, 0.82) and 0.81 (0.47, 1.42), respectively. The adjusted RR of infant SGA for maternal downward (compared to lifelong residence in affluent neighborhoods) economic mobility among fathers with early-life low and high SEP were 1.37 (0.91, 2.05) and 1.17 (0.86, 1.59), respectively.

CONCLUSIONS

Paternal early-life SEP is associated with maternal economic mobility (both upward and downward); however, it does not modify the relationship between maternal economic mobility and infant SGA rates.

The prognostic and diagnostic implications of surveillance serial myocardial perfusion imaging in asymptomatic renal transplant candidates

BACKGROUND

The utility of serial SPECT myocardial perfusion imaging (MPI) for CAD surveillance in asymptomatic ESRD patients awaiting kidney transplantation (KT) is uncertain.

METHODS AND RESULTS

We retrospectively investigated 700 asymptomatic KT candidates with ≥ 2 pre-transplant SPECT-MPIs (mean interval, 20 ± 13 months). Worsening MPI was defined as total perfusion deficit increase (ΔTPD) > 5%. High clinical risk was defined as ≥ 3 AHA/ACC KT risk factors. The primary outcome was major adverse cardiac events (MACE) of cardiac death or myocardial infarction. The initial MPI was normal in 462 (66%) subjects. On repeat MPI, ΔTPD > 5% was observed in 82 (12%) subjects, and the incidence increased with increasing time gap between MPIs (P = .006). During a mean follow-up of 16 ± 8 months, there were 119 (17%) MACEs. In the entire cohort, ΔTPD > 5% was not significantly associated with MACE (HR = 1.38; P = .210). ΔTPD > 5% was associated with increased MACE rate among patients with normal initial MPI (HR = 2.30; P = .005), but not among those with abnormal initial MPI (P = .260). There was a significant interaction between ΔTPD > 5% and initial MPI normalcy status in predicting MACE (interaction P = .018), such that the predictive value of ΔTPD is dependent on the initial MPI normalcy. Among subjects with normal initial MPI, ΔTPD > 5% was significantly associated with MACE only if the sum of KT risk factors was ≥ 3 (HR = 2.26; P = .016). Among 123 patients who underwent coronary angiography, ΔTPD > 5% was associated with a higher prevalence of obstructive CAD when the initial MPI was normal and the sum of KT risk factors was ≥ 3.

CONCLUSION

Among patients with ESRD waitlisted for KT, new/worsening MPI abnormalities are expected. On serial surveillance, ΔTPD > 5% is associated with MACE and obstructive CAD among those with a normal initial MPI and ≥ 3 AHA/ACC KT risk factors.

Two rotavirus outbreaks caused by genotype G2P[4] at large retirement communities: cohort studies

BACKGROUND

Outbreaks of rotavirus gastroenteritis in elderly adults are reported infrequently but are often caused by G2P[4] strains. In 2011, outbreaks were reported in 2 Illinois retirement facilities.

OBJECTIVE

To implement control measures, determine the extent and severity of illness, and assess risk factors for disease among residents and employees.

DESIGN

Cohort studies using surveys and medical chart abstraction.

SETTING

Two large retirement facilities in Cook County, Illinois.

PATIENTS

Residents and employees at both facilities and community residents with rotavirus disease.

MEASUREMENTS

Attack rates, hospitalization rates, and rotavirus genotype.

RESULTS

At facility A, 84 of 324 residents (26%) were identified with clinical or laboratory-confirmed rotavirus gastroenteritis (median age, 84 years) and 11 (13%) were hospitalized. The outbreak lasted 7 weeks. At facility B, 90 case patients among 855 residents (11%) were identified (median age, 88 years) and 19 (21%) were hospitalized. The facility B outbreak lasted 9.3 weeks. Ill employees were identified at both locations. In each facility, attack rates seemed to differ by residential setting, with the lowest rates among those in more separated settings or with high baseline level of infection control measures. The causative genotype for both outbreaks was G2P[4]. Some individuals shed virus detected by enzyme immunoassay or genotyping reverse transcription polymerase chain reaction for at least 35 days. G2P[4] was also identified in 17 of 19 (89%) samples from the older adult community but only 15 of 40 (38%) pediatric samples.

LIMITATION

Medical or cognitive impairment among residents limited the success of some interviews.

CONCLUSION

Rotavirus outbreaks can occur among elderly adults in residential facilities and can result in considerable morbidity. Among older adults, G2P[4] may be of unique importance. Health professionals should consider rotavirus as a cause of acute gastroenteritis in adults.

PRIMARY FUNDING SOURCE

None.

Investigation of the first laboratory-acquired human cowpox virus infection in the United States

BACKGROUND

Cowpox virus is an Orthopoxvirus that can cause infections in humans and a variety of animals. Infections occur in Eurasia; infections in humans and animals have not been reported in the United States. This report describes the occurrence of the first known human case of laboratory-acquired cowpox virus infection in the United States and the ensuing investigation.

METHODS

The patient and laboratory personnel were interviewed, and laboratory activities were reviewed. Real-time polymerase chain reaction (PCR) and serologic assays were used to test the patient's specimens. PCR assays were used to test specimens obtained during the investigation.

RESULTS

A specimen from the patient's lesion tested positive for cowpox virus DNA. Genome sequencing revealed a recombinant region consistent with a strain of cowpox virus stored in the research laboratory's freezer. Cowpox virus contamination was detected in 6 additional laboratory stocks of viruses. Orthopoxvirus DNA was present in 3 of 20 environmental swabs taken from laboratory surfaces.

CONCLUSIONS

The handling of contaminated reagents or contact with contaminated surfaces was likely the mode of transmission. Delays in recognition and diagnosis of this infection in a laboratory researcher underscore the importance of a thorough patient history-including occupational information-and laboratory testing in facilitating a prompt investigation and application of control and remediation measures.

Hip protectors: recommendations for conducting clinical trials--an international consensus statement (part II)

INTRODUCTION

While hip protectors are effective in some clinical trials, many, including all in community settings, have been unable to demonstrate effectiveness. This is due partly to differences in the design and analysis. The aim of this report is to develop recommendations for subsequent clinical research.

METHODS

In November of 2007, the International Hip Protector Research Group met to address barriers to the clinical effectiveness of hip protectors. This paper represents a consensus statement from the group on recommended methods for conducting future clinical trials of hip protectors.

RESULTS AND CONCLUSIONS

Consensus recommendations include the following: the use of a hip protector that has undergone adequate biomechanical testing, the use of sham hip protectors, the conduct of clinical trials in populations with annual hip fracture incidence of at least 3%, a run-in period with demonstration of adequate adherence, surveillance of falls and adherence, and the inclusion of economic analyses. Larger and more costly clinical trials are required to definitively investigate effectiveness of hip protectors.

Hip protectors: recommendations for biomechanical testing--an international consensus statement (part I)

INTRODUCTION

Hip protectors represent a promising strategy for preventing fall-related hip fractures. However, clinical trials have yielded conflicting results due, in part, to lack of agreement on techniques for measuring and optimizing the biomechanical performance of hip protectors as a prerequisite to clinical trials.

METHODS

In November 2007, the International Hip Protector Research Group met in Copenhagen to address barriers to the clinical effectiveness of hip protectors. This paper represents an evidence-based consensus statement from the group on recommended methods for evaluating the biomechanical performance of hip protectors.

RESULTS AND CONCLUSIONS

The primary outcome of testing should be the percent reduction (compared with the unpadded condition) in peak value of the axial compressive force applied to the femoral neck during a simulated fall on the greater trochanter. To provide reasonable results, the test system should accurately simulate the pelvic anatomy, and the impact velocity (3.4 m/s), pelvic stiffness (acceptable range: 39-55 kN/m), and effective mass of the body (acceptable range: 22-33 kg) during impact. Given the current lack of clear evidence regarding the clinical efficacy of specific hip protectors, the primary value of biomechanical testing at present is to compare the protective value of different products, as opposed to rejecting or accepting specific devices for market use.

Dorsal hippocampal kindling produces a selective and enduring disruption of hippocampally mediated behavior

Kindling produces enduring neural changes that are subsequently manifest in enhanced susceptibility to seizure-evoking stimuli and alterations in some types of behavior. The present study investigated the effects of dorsal hippocampal (dHPC) kindling on a variety of behaviors to clarify the nature of previously reported effects on spatial task performance. Rats were kindled twice daily with dHPC stimulation until three fully generalized seizures were evoked. Beginning 7 d later and on successive days, rats were tested in an elevated plus maze, a large circular open field, an open field object exploration task, and a delayed-match-to-place (DMTP) task in a water maze to assess anxiety-related and activity-related behavior (tasks 1 and 2), object recognition memory (task 3), and spatial cognition (task 4). Kindling disrupted performance on the DMTP task in a manner that was not delay dependent and produced a mild enhancement of activity-related behaviors in the open field task but not the elevated plus maze. All other aspects of testing were spared. These findings indicate that dHPC kindling produces enduring and selective effects on behavior that are consistent with a restricted disruption of hippocampally mediated functions. Possible bases for these effects are changes in local NMDA receptor function and/or changes in local inhibition, which might alter the optimal conditions for experience-dependent induction of intrahippocampal plasticity. This preparation may be useful for studying the mechanisms of mnemonic dysfunction associated with temporal lobe epilepsy and may offer unique insights into the mechanisms underlying normal hippocampal function.

Susceptibility to kindling and neuronal connections of the anterior claustrum

The claustrum has been implicated in the kindling of generalized seizures from limbic sites. We examined the susceptibility of the anterior claustrum itself to kindling and correlated this with an anatomical investigation of its afferent and efferent connections. Electrical stimulation of the anterior claustrum resulted in a pattern of rapid kindling with two distinct phases. Early kindling involved extremely rapid progression to bilaterally generalized seizures of short duration. With repeated daily kindling stimulations, early-phase generalized seizures abruptly became more elaborate and prolonged, resembling limbic-type seizures as triggered from the amygdala. We suggest that the rapid rate of kindling from the anterior claustrum is an indication that the claustrum is functionally close to the mechanisms of seizure generalization. In support of our hypothesis, we found significant afferent, efferent, and often reciprocal connections between the anterior claustrum and areas that have been implicated in the generation of generalized seizures, including frontal and motor cortex, limbic cortex, amygdala, and endopiriform nucleus. Additional connections were found with various other structures, including olfactory areas, nucleus accumbens, midline thalamus, and brainstem nuclei including the substantia nigra and the dorsal raphe nucleus. The anatomical connections of the anterior claustrum are consistent with its very high susceptibility to kindling and support the view that the claustrum is part of a forebrain network of structures participating in the generalization of seizures.

Personal values and sexual decision-making among virginal and sexually experienced urban adolescent girls

PURPOSE

To guide the development of an intervention to reduce the incidence of sexually transmitted diseases (STDs) in urban, adolescent girls, we investigated such girls' reasons for deciding to have or not to have sexual intercourse.

METHODS

Consecutive girls >or=14 years of age attending an urban adolescent clinic were invited to complete an anonymous survey about sexual decision-making. In this pilot study, girls were asked: (a) whether they agreed with a statement that they had or had not had sexual intercourse "because of my values and beliefs"; and (b) to select from a list one or more specific reasons why they had or had not had intercourse. The girls were categorized by self-report as either "virgins," "currently inactive" (no intercourse in the preceding 3 months), or "currently active" (had intercourse during the preceding 3 months).

RESULTS

Usable surveys were obtained from 197 adolescents whose age (18.2 +/- 2.6 years) and race (69% black) were comparable to those of clinic attendees in general. Forty girls (20%; age 16.1 +/- 2.1 years) were virgins, 25 girls (13%; age 17.8 +/- 2.3 years) were inactive, and 132 girls (67%; age 18.9 +/- 2.5 years) were currently active. "Values and beliefs" were cited as the reason for decisions about sexual behavior by 53% of the virgins, but only by 24% of the sexually inactive and 24% of the sexually active girls (p = .002). Virgins were more likely than inactive girls to cite three specific reasons for not having sex: "not the right thing for me now" (82% vs. 50%, p = .007), "waiting until I am older" (69% vs. 8%, p = .001), and "waiting until I am married" (67% vs. 38%, p = .02). The reason "against my religious beliefs" was cited by 23% of virgins and 13% of inactive girls (p = not significant). Personal values were implicit in the two specific reasons for having sex that active girls chose most frequently, namely, "I like/love the person" (86%) and "I like having sex" (37%), although only 24% of these girls had explicitly cited "values and beliefs" as their reason for having sex.

CONCLUSIONS

Our data indicate that urban girls, both those who have had sexual intercourse and those who have not, view their sexual behavior as being based on personal (although infrequently religious) values. Many of the virginal urban, adolescent girls we surveyed hold abstinence as a personal value. The sexually active adolescents perceive the decision to have sexual intercourse as being based affirmatively on their personal values rather than on the chance occurrence of opportunities to have intercourse. These data may be useful in the development of new strategies for reducing urban adolescent girls' risk of acquiring sexually transmitted diseases.

Effects of low-dose alcohol exposure on simulated merchant ship piloting by maritime cadets

The US Department of Transportation (DOT) regulates on-the-job alcohol use by operators of certain categories of commercial transport. For aircraft, trains, and commercial vessels, operators are subject to sanctions for having > or = 0.04 g% blood alcohol concentration (BAC). This study examines the effects of alcohol (between 0.04 and 0.05 g% BAC) on simulated merchant ship handling. A two-group randomized factorial design was used to compare beverage alcohol to placebo while controlling for baseline performance on a previous day. The study was conducted in the Maritime Simulation Center at Maine Maritime Academy, Castine, ME. Participants were 38 volunteer deck officer cadets in their junior or senior year, at least 21 years of age, with previous experience on a bridge simulator. Following a baseline trial on Day 1, on Day 2 participants were randomized to receive alcohol (0.6 g/kg for males and 0.5 g/kg for females) or placebo. After allowing time for absorption, participants completed a bridge simulator task. For baseline and performance trials, participants were randomized to one of four bridge simulator scenarios, each representing passage of a fully loaded container vessel through a channel with commercial traffic. The aggregate scenario score given by blinded maritime educators measured performance. A main effect for alcohol was found indicating that performance was significantly impaired by this low dose of alcohol relative to performance in the placebo condition. These findings are consistent with current federal regulations that limit low-dose alcohol exposure for the operators of commercial transport vehicles. Further research is required to determine effects at lower BACs.

Initial sequencing and analysis of the human genome

The human genome holds an extraordinary trove of information about human development, physiology, medicine and evolution. Here we report the results of an international collaboration to produce and make freely available a draft sequence of the human genome. We also present an initial analysis of the data, describing some of the insights that can be gleaned from the sequence.

Age of drinking onset and unintentional injury involvement after drinking

CONTEXT

In 1997, unintentional injury was the leading cause of death for persons aged 1 to 34 years. Approximately one third of deaths due to unintentional injury in the United States are estimated to be alcohol related. Onset of drinking at an early age has been found to be associated with alcohol dependence, but whether early-onset drinking increases risk for unintentional injury while drinking is unknown.

OBJECTIVE

To explore whether persons who started drinking at an early age are more likely to have experienced unintentional injuries while under the influence of alcohol.

DESIGN AND SETTING

The National Longitudinal Alcohol Epidemiology Survey, a cross-sectional survey conducted in 1992 of a representative sample of the US population.

PARTICIPANTS

A total of 42,862 randomly selected adults (response rate, 90%; mean age, 44 years).

MAIN OUTCOME MEASURES

Unintentional injury involvement while under the influence of alcohol by age of drinking onset (categorized as <14 years, each age from 14-20 years, or >/=21 years).

RESULTS

Relative to respondents who began drinking at age 21 years or older, those who started before age 14 years as well as those who started at each intervening age up to 21 years were significantly more likely to have been injured while under the influence of alcohol, even after controlling for history of alcohol dependence, heavy drinking frequency during the period that they drank most, family history of alcoholism, and other characteristics associated with earlier onset of drinking. After adjusting for these variables, odds ratios for having been injured while under the influence of alcohol were as follows: for younger than 14 years, 2.98 (95% confidence interval [CI], 2.29-3.89); age 14 years, 2.96 (95% CI, 2.26-3.88); age 15 years, 3.14 (95% CI, 2.48-3.97); age 16 years, 2.38 (95% CI, 1.90-2.98); age 17 years, 2.12 (95% CI, 1.66-2.71); age 18 years, 1. 33 (95% CI, 1.08-1.64); age 19 years, 1.42 (95% CI, 1.07-1.89); and age 20 years, 1.39 (95% CI, 1.01-1.91).

CONCLUSION

Drinking onset at ages younger than 21 years is associated with having experienced alcohol-related injuries. JAMA. 2000;284:1527-1533

Effects of low-dose alcohol exposure on simulated merchant ship handling power plant operation by maritime cadets

AIMS

Under current US Department of Transportation (DOT) regulations, some commercial vehicle operators are subject to sanctions for having > or = 00.04 g% blood alcohol concentrations (BACs) on the job. This study investigated the effects of alcohol (between 0.04 and 0.05 g% BAC) on the simulated operation of a commercial ship's power plant.

DESIGN

A balanced placebo design was used in which alcohol administration was fully crossed with expectancy that alcohol was administrated.

SETTING

The study was conducted at the Massachusetts Maritime Academy, Buzzards Bay, MA, USA.

PARTICIPANTS

Participants were 18 volunteer engineering students in their senior year, at least 21 years of age, with previous experience on the diesel simulator.

INTERVENTION

Following a baseline trial on day 1, on day 2 participants were randomized to expectancy (told alcohol or placebo) and beverage (receive alcohol or placebo). The dosage was 0.6 g/kg for males and 0.5 g/kg for females. In both baseline and performance days, participants were randomized to one of four diesel simulator scenarios, each replicating a system failure in a power plant subsystem (e.g. main propulsion, electrical generating).

MEASUREMENT

Performance was measured by time required for problem identification and remediation.

FINDINGS

A main effect for alcohol administration was found. In the alcohol condition, simulator performance time was almost twice as long (351 sec) as on the placebo condition (186 sec). The expectancy effect was not significant.

CONCLUSION

These findings support the current federal policy on the hazards of this low alcohol level within the context of commercial shipping.

Boater training, drinking and boating, and other unsafe boating practices

OBJECTIVES

Identify associations between lack of formal boater training, drinking and boating, and other unsafe boating practices.

METHODS

A telephone survey queried respondents (age 16 or older in continental United States) about boating experience, type of boat used, and training.

RESULTS

Of the 3,042 boaters surveyed (70% response), most had no formal training (73%). Boaters with formal training failed to use PFDs about as often as those without formal training and were equally or more likely to use alcohol while boating.

CONCLUSIONS

The unexpected association between formal training and unsafe boating practices is probably due to reduced risk perception and inadequacies of boater training programs. Such programs seldom mention the risks of alcohol use while boating. Decisions to mandate formal training should be informed by these results; if mandated, training should address the risks of alcohol use while boating, and should be renewed frequently enough to offset reductions in risk perception.

Employee drinking practices and work performance

OBJECTIVE

The purpose of this study was to examine the independent effects of a variety of drinking indicators on self-reported work performance.

METHOD

Data from a cross-sectional mailed survey (response rate = 71%) of managers, supervisors and workers (N = 6,540) at 16 worksites were analyzed. Average daily volume was computed from frequency and usual quantity reports. Drinking on the job included drinking during any of six workday situations. The CAGE was used to indicate alcohol dependence. Employees were also asked how frequently they drank to get high or drunk. Work performance was measured through a series of questions about work problems during the prior year. The number of times respondents experienced work performance problems was regressed on the four drinking measures, and a variety of demographic characteristics, job characteristics and life circumstances that might also negatively affect work performance.

RESULTS

The frequency of self-reported work performance problems increased, generally, with all four drinking measures. In a multivariate model that controlled for a number of demographics, job characteristics and life-situations, average daily volume was no longer significantly associated with work performance but the other three drinking measures were. Interestingly, although moderate-heavy and heavy drinkers reported more work performance problems than very light, light, or moderate drinkers, the lower-level-drinking employees, since they were more plentiful, accounted for a larger proportion of work performance problems than did the heavier drinking groups.

CONCLUSIONS

Employers should develop clear policies limiting drinking on the job and, in addition to employee assistance programs for problem drinkers, should develop worksite educational interventions aimed at informing all employees about the relationship between drinking behaviors and work performance.

Did changes in minimum age drinking laws affect adolescent drowning (1970-90)?

OBJECTIVE

To test the hypothesis that changes in the minimum legal drinking age (MLDA) laws would affect drowning among adolescents, the effects of changes in state MLDA laws on drowning were examined for the targeted (18-20 years) and two adjacent (15-17 years and 21-23 years) age groups, over a period of 21 years (1970-90).

METHODS

Poisson maximum likelihood regression was used to estimate the effects of both lowering and increasing the MLDA. The dependent variable in these analyses was the number of drownings per state per year for the age groups observed. At first only state and year effects were controlled for and then any other variable potentially associated with the incidence of drowning was included. The other control variables included proportion of population living near border states with lower MLDA laws, urbanicity, unemployment, divorce, education, poverty, beer tax, and proxy measures for MLDA law enforcement.

RESULTS

No significant association between drowning and MLDA was found for any of the age groups studied.

CONCLUSION

It is concluded that MLDA laws are not an important public policy strategy for affecting drowning rates among adolescents and young adults.

A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults

A randomized, single-blind controlled trial was conducted to test the efficacy of a community-based group intervention to reduce fear of falling and associated restrictions in activity levels among older adults. A sample of 434 persons age 60+ years, who reported fear of falling and associated activity restriction, was recruited from 40 senior housing sites in the Boston metropolitan area. Data were collected at baseline, and at 6-week, 6-month, and 12-month follow-ups. Compared with contact control subjects, intervention subjects reported increased levels of intended activity (p < .05) and greater mobility control (p < .05) immediately after the intervention. Effects at 12 months included improved social function (p < .05) and mobility range (p < .05). The intervention had immediate but modest beneficial effects that diminished over time in the setting with no booster intervention.

Covariates of fear of falling and associated activity curtailment

With a sample survey (N = 266) of elderly adults residing in six housing developments in Massachusetts, we used logistic regression to: (a) identify covariates of fear of falling among all subjects and (b) identify covariates of activity curtailment among the subset of subjects who were afraid of falling. Fifty-five percent of respondents were afraid of falling; of those who were afraid, 56% had curtailed activity due to this fear. Factors associated with fear of falling were: being female, having had previous falls, and having fewer social contacts. Factors associated with activity curtailment among those who were afraid were: not communicating about falls; having less social support; and knowing someone who had fallen. Falls history appears an important contributor to fear of falling, whereas the impact of this fear on activities appears more a function of social support. These findings suggest different strategies for the primary and secondary prevention of fear of falling.

Intensity and correlates of fear of falling and hurting oneself in the next year: baseline findings from a Roybal Center fear of falling intervention

Fear of falling is highly prevalent and associated with restricted activity. To help inform design of interventions, the authors examined the correlates of this fear. Data came from baseline information on subjects in a community-based falls intervention study (N = 392). In a multivariate model, lower levels of fear of falling and hurting oneself in the next year were related to being younger, having higher levels of dysfunction, and having lower levels of perceived ability to manage falls, with the last two remaining significant even after controlling for generalized fearfulness. When analyzing specific domains of dysfunction, higher levels of fear of falling and hurting oneself in the next year were associated with higher levels of physical dysfunction. The findings lend support to the expanding awareness that fear of falling may imperil quality of life and suggest the importance of interventions aimed at enhancing ability to manage falls.

Fear of falling and activity restriction: the survey of activities and fear of falling in the elderly (SAFE)

A new instrument was developed to assess the role of fear of falling in activity restriction. The instrument assesses fear of falling during performance of 11 activities, and gathers information about participation in these activities as well as the extent to which fear is a source of activity restriction. The instrument demonstrated good internal consistency reliability and showed convergent validity with other fear of falling measures. Concurrent (empirical) validity was demonstrated in that the scale was effective in differentiating among those who were expected to be afraid vs. not afraid of falling. Criterion validity was examined in relation to quality of life variables. Fear of falling was shown to be related to lower quality of life, even when controlling for related background factors. One advantage of this measure over existing measures is the possibility for differentiating fear of falling that leads to activity restriction from fear of falling that accompanies activity. This may provide useful information for those interested in treating fear of falling of promoting activity among the elderly.

Sunbathing habits and sunscreen use among white adults: results of a national survey

OBJECTIVES

This study assessed current levels of sunbathing and sunscreen use in the United States.

METHODS

From a general-population telephone survey of aquatic activities among adults in 3042 US households, we examined responses by the 2459 Whites.

RESULTS

Most adults (59%) reported sunbathing during the past year, and 25% reported frequent sunbathing. Of the subsample who reported sunbathing during the month before the interview, 47% routinely used sunscreen. Of these individuals, almost half did not use sunscreens with a solar protection factor of 15 or higher.

CONCLUSIONS

About a quarter of US White adults report frequent sunbathing, and only about a quarter of sunbathers use sunscreens at recommended levels. These results should help focus future sun protection educational efforts.

State-level clustering of safety measures and its relationship to injury mortality

This article proposes a social model of investigating injury mortality. The authors hypothesize that (1) state-level laws and regulations on safety cluster together in one or more groupings; (2) groupings of safety measures play a significant role in injury mortality; and (3) injury mortality is very highly associated with social structural variables. There is a clustering of safety policies, with five factors explaining 67 percent of variance, although no "master factor" was discovered. The strongest factor, explaining 21 percent of variance, includes three gun laws and low speed limits before the 1973 federal law. One factor is the most global in that it taps three distinct areas, including helmet laws, minor blood alcohol levels, and smoke detectors, though it only explains 7.5 percent of variance. The only factor that remains in a regression for injury mortality is one that includes strong seat belt laws and strong enforcement of those laws, though in the direction opposite to that hypothesized. This factor, along with percentage rural and environmental spending per capita, is significant for both motor vehicle and non-motor vehicle mortality. For motor vehicle mortality alone, deaths are higher in states with higher percentages of Hispanics and fewer people receiving food stamps and AFDC. Many factors that usually predict individual injury mortality do not hold at the state level, suggesting the usefulness of looking at social factors for new insights into injury mortality and prevention.

Worksite barriers to the effective management of alcohol problems

The purpose of this analysis is to describe barriers to workplace interventions in cases of alcohol abuse. A survey of 7255 supervisors in 114 worksites across seven major corporations was completed (79% responded). Information about barriers to intervention was elicited by 12 questions. Cluster analysis revealed three analytically independent classes of barriers--Organizational, Interpersonal, and Individual. Most managers reported encountering some barriers to intervention: the extent of barriers perceived was related to characteristics of the worksite, job, and/or the environment. Barriers were greatest for female managers, managers in larger worksites, and the first-line supervisors. Barriers were also related to the form (formal vs informal) of intervention a manager was willing to make. Intervention strategies must take into account differences between company worksites and job levels, and not assume that policies are equally effective throughout the corporation.

Employee attitudes toward work-site alcohol testing

Few studies have been published on how employees feel about work-site alcohol testing. By mail, we surveyed employees (n = 6370) at 16 corporate work sites stratified by type of work force, industrial setting, and managerial tolerance toward drinking. We queried respondents about their drinking on the job and support for work-site alcohol testing under three conditions: pre-employment testing, testing after an accident, and random testing. Sixty-five percent of respondents supported pre-employment testing, 81% supported testing after an accident, and 49% supported random testing. Support was relatively consistent across hierarchy (managers, supervisors, and workers) but different by age, education, occupation, type of work force, and perceived exposure to occupational hazards. Support for work-site alcohol testing was highest among blue-collar workers whose jobs involved manufacturing or exposure to work-site hazards.

Insulin and secretagogues differentially regulate fluid-phase pinocytosis in insulin-secreting beta-cells

The physiological role of the beta-cell insulin receptor is unknown. To evaluate a candidate function, the insulin regulation of fluid-phase pinocytosis was investigated in a clonal insulinoma cell line (beta TC6-F7) and, for comparison, also in Chinese hamster ovary cells transfected with the human insulin receptor (CHO-T cells). In CHO-T cells, the net rate of fluid-phase pinocytosis was rapidly increased 3-4-fold over the basal rate by 100 nM insulin, with half-maximal stimulation at 2 nM insulin, as assayed by cellular uptake of horseradish peroxidase from the medium. Wortmannin, an inhibitor of phosphatidylinositol (PI)-3-kinase, blocked insulin-stimulated pinocytosis with an IC50 of 7.5 nM without affecting the basal rate of pinocytosis. In insulin-secreting beta TC6-F7 cells, the secretagogues glucose and carbachol (at maximally effective concentrations of 15 mM and 0.5 mM respectively) augmented fluid-phase pinocytosis 1.65-fold over the basal rate. Wortmannin also inhibited secretagogue-stimulated pinocytosis in these beta-cells with an IC50 of 7 nM but did not affect the basal rate of pinocytosis measured in the absence of secretagogues. Wortmannin did not influence either basal or secretagogue-induced insulin secretion. Although these beta TC6-F7 cells have cell-surface insulin receptors, adding exogenous insulin or insulin-like growth factor 1 did not affect their rate of fluid-phase pinocytosis, either in the absence or presence of secretagogues. From these observations, we conclude that: (1) in both insulin-secreting beta-cells and in conventional, insulin-responsive CHO-T cells, a common, wortmannin-sensitive reaction, which probably involves PI-3-kinase, regulates fluid-phase pinocytosis; (2) the insulin-receptor signal transduction pathway is dissociated from the regulation of fluid-phase pinocytosis in the insulin-secreting beta-cell line we studied; and (3) the enhancement of fluid-phase pinocytosis associated with secretagogue-induced insulin release in beta TC6-F7 cells is not attributable to autocrine activation of beta-cell surface insulin receptors.

Work-site variation in managerial drinking

To assess cross-work-site variation in the general drinking behaviors (on and off the job) of employees, we conducted a cross-sectional survey of managers (n = 7255) at 114 places of work located throughout the continental United States. The work-site mean for the total number of drinks consumed on a typical drinking day ranged from 1.4 to 3.17, a two-fold differential. Regression analysis showed an independent work-site effect, controlling for respondents demographics and type of work. This finding suggests that modifiable work-site characteristics could influence what employees drink on and off the job.

Reducing alcohol-impaired driving in Massachusetts: the Saving Lives Program

OBJECTIVES

The purpose of this study ws to assess whether a community program begun in March 1988 that organized multiple city departments and private citizens could reduce alcohol-impaired driving, related driving risks, and traffic deaths and injuries.

METHODS

Trends in fatal crashes and injuries per 100 crashes were compared in Saving Lives Program cities and the rest of Massachusetts from March 1984 through February 1993. In annual roadside surveys conducted at randomly selected locations, safety belt use among occupants of 54577 vehicles and travel speeds of 118442 vehicles were observed. Four statewide telephone surveys (n = 15188) monitored self-reported driving after drinking.

RESULTS

In program cities relative to the rest of Massachusetts during the 5 program years in comparison with the previous 5 years, fatal crashes declined 25%, from 178 to 120, and fatal crashes involving alcohol decreased 42%, from 69 to 36. Visible injuries per 100 crashes declined 5%, from 21.1 to 16.6. The proportions of vehicles observed speeding and teenagers who drove after drinking were cut in half.

CONCLUSIONS

Interventions organized by multiple city departments and private citizens can reduce driving after drinking, related driving risks, and traffic deaths and injuries.

Expression of insulin receptor mRNA and insulin receptor substrate 1 in pancreatic islet beta-cells

The expression of insulin receptor mRNA was examined in rat pancreatic islet cells by single-cell reverse transcriptase (RT)-polymerase chain reaction (PCR). Single cells from disaggregated islets were individually isolated in a microcapillary pipet, and the beta-cells were identified by amplification of the mRNA for insulin. We found that in single beta-cells, the mRNA for the insulin receptor was also expressed. The fraction of single islet cells expressing both insulin receptor and insulin mRNAs corresponds closely to the fraction of beta-cells in the disaggregated islet cell preparation. These results indicate that normal beta-cells have the potential to express authentic insulin receptors. Immunohistochemical analysis was insufficiently sensitive for assaying insulin receptor protein; however, insulin receptor substrate 1 (IRS-1) was readily immunolocalized in islet beta-cells. Since IRS-1 links several cell surface receptors, including those for insulin and IGF-I, to distal signal transduction pathways, our observations indicate that hormonal regulation of islet beta-cells potentially involves the same signal transduction pathway that mediates insulin and growth factor signaling in peripheral insulin target tissue cell types.

Perceptions of risks of drinking and boating among Massachusetts boaters

OBJECTIVES

Public policy has treated drinking and boating as though it were analogous to drinking and driving. Accordingly, recent Federal and state laws to prevent drinking and boating have focused solely on alcohol use by the boat operator. This study was designed to determine boaters' knowledge about the epidemiology of boating fatalities and how boaters perceive the risks of drinking and boating.

METHODS

In the summer of 1995, the authors conducted a survey by mail of a random sample of 600 owners of boats registered in Massachusetts.

RESULTS

Survey results indicated that boaters believe passengers can safely drink more than operators. Respondents also thought that people on boats at rest can safely drink more than people on boats underway.

CONCLUSIONS

The results of this study could be helpful in designing future boating safety campaigns by identifying gaps in knowledge about about the risks of drinking and boating for both operators and passengers.

Why are most drowning victims men? Sex differences in aquatic skills and behaviors

Men have higher drowning rates than women for most age groups. Data from a 1991 national household survey (n = 3042) on aquatic activities were used to examine hypotheses about differential drowning rates by sex. Men and women were compared by (1) exposure to aquatic environments; (2) frequency of aquatic activities involving or potentially involving, submersion; (3) swimming training and ability; (4) aquatic risk-taking behaviors; and (5) alcohol use on or near the water. Men had elevated risks for exposure, risk taking, and alcohol use. It was concluded that several factors contribute to their relatively high drowning rates, including a possible interaction between overestimation of abilities and heavy alcohol use.

Predicting radon testing among university employees

To determine covariates of radon testing behavior, we surveyed by mail a random sample of all Boston University employees (N = 915) six to nine months after they had been informed of the availability of radon testing services through the University's medical center. The response rate was 58%. Analysis suggests blue collar workers were underrepresented within the response rate. Slightly more than half of the respondents (51%) were men. The majority (69%) were under the age of 45. Twenty-seven percent of the respondents (N = 143) had tested their homes for radon. Bivariate analysis revealed important differences between radon testers and nontesters. Testers were 12 times more likely to be home owners than renters (p = 0.00), and were more knowledgeable about radon's characteristics and testing procedures (p = 0.00). Testers were more likely to view radon as a serious problem (p = 0.00), to consider radon testing efficacious (p = 0.00), and to consider themselves susceptible to exposure (p = 0.00). Testers were also less likely to perceive barriers to radon testing. We used logistic regression to compare the usefulness of the Health Belief Model and the Diffusion of Innovations Model in predicting radon testing. We concluded that the knowledge deficits and barriers to radon testing identified in this study should be targeted in radon educational interventions.

Laparoscopic assisted vaginal hysterectomy: an audit plus a word of caution

Laparoscopic assisted vaginal hysterectomy (LAVH) performed in 109 cases has been reviewed. In this series the mean operative time was 89 minutes and mean inpatient hospitalization was 3.7 days. Throughout the review, 6 patients were considered to have major complications and each is discussed. The association of previous caesarean section and bladder damage is noted. LAVH widens the indications available for vaginal hysterectomy in younger women in whom the abdominal approach would previously be indicated, but extra caution is advised when this technique is first introduced to a gynaecological service.

Evaluation of an office- and hospital-based intervention to increase the use of cloth diapers

To evaluate an office-based educational intervention to promote the use of cloth diapers, we randomly assigned parents of 193 infants either to the intervention group or to a control group. The intervention consisted of physician advice and written material on cloth and disposable diapers at the 2-week office visit. Midway through the study, one of the birth hospitals switched to the exclusive use of cloth diapers. The results indicate that the diapering decisions of parents can be influenced by practices in hospitals and by office-based physician and nurse counseling.

Alcohol and non-traffic unintended injuries

In a review of the English language literature on alcohol and unintentional injury we identified 21 studies on falls, 36 on drownings and 32 on burns from 1947-1986. The proportion of fatal and non-fatal fall victims who had been drinking ranged from 21-77%, and 18-53% respectively. In three more recent studies, 35-63% of persons fatally injured in falls had been drinking. In five other studies 13-37% of persons injured in non fatal falls had been drinking. In our earlier review of drowning studies with complete ascertainment and duration of submergence specified, 27-47% of those who drowned had positive BAC's. In eight subsequent studies, alcohol was identified in 21-47% of drowning deaths. In our earlier review alcohol was involved in 9-86% of burn deaths. In five more recent US studies, alcohol was found in 12-61% of fatally injured burn victims. Case control studies are needed to establish whether alcohol increases the risk of trauma. Studies are also needed of interventions to reduce the proportion of these injuries where alcohol is involved.

Fear of falling among the community-dwelling elderly

To assess the incidence of falls and the prevalence, intensity, and covariates of fear of falling among community-dwelling elderly, the authors surveyed a random sample of 196 residents (> or = 58 years of age) of housing developments for the elderly in Brookline and Plymouth, Massachusetts. Forty-three percent reported having fallen in recent years, 28% in the last year. Of those who had fallen within the year prior to the interview, 65% reported injury, 44% sought medical attention, and 15% required hospitalization as a consequence of their fall(s). Fear of falling ranked first when compared to other common fears (i.e., fear of robbery, financial fears). Self-rated health status and experience of previous falls were significantly associated with fear of falling. Further analysis suggests that fear of falling may affect social interaction, independent of risks for falling.

Using chronic disease risk factors to adjust Medicare capitation payments

This study evaluates the use of risk factors for chronic disease as health status adjusters for Medicare's capitation formula, the average adjusted per capita costs (AAPCC). Risk factor data for the surviving members of the Framingham Study cohort who were examined in 1982-83 were merged with 100 percent Medicare payment data for 1984 and 1985, matching on Social Security number and sex. Seven different AAPCC models were estimated to assess the independent contributions of risk factors and measures of prior utilization and disability in increasing the explanatory power of AAPCC. The findings suggest that inclusion of risk factors for chronic disease as health status adjusters can improve substantially the predictive accuracy of AAPCC.